Frågedatum: 1993-05-11
RELIS database 1993; id.nr. 9490, DRUGLINE
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A 23-year-old patient has been treated for endometriosis with Provera (medroxyprogesterone) 10 mg x



Fråga: A 23-year-old patient has been treated for endometriosis with Provera (medroxyprogesterone) 10 mg x1 per day for six months. One month ago the patient was found to have increased blood glucose levels. The patient feels tired and thirsty. Could medroxyprogesterone cause increased blood glucose levels?

Sammanfattning: Increased blood glucose levels after a long duration of medroxyprogesterone use has been reported in limited studies. This drug effect is reversible and there is no report of diabetes caused by the use of this drug.

Svar: The effects of medroxyprogesterone (Depo-Provera) on the metabolism of glucose has been studied (1-2) and reviewed (3). Fahmy and co-workers have investigated 20 women who received Depo-Provera intramuscularly in a dose of 150 mg every 90 +/- 5 days for 12 months. A significant increase in mean blood glucose levels (with standardized 75 gram oral glucose tolerance test) was observed after 12 months treatment. However, the increase in blood glucose levels was modest, although significant, and the mean 2-hour serum glucose level was still below the 2-hour lower cut-off level of impaired glucose level (140 mg/dl) (1). Similar results have also been reported in 32 women included in another study (2). In addition, medroxyprogesterone use has been shown to be associated with significantly higher mean 2-hour serum insulin levels after six months (1). The effect of this drug on carbohydrate metabolism disappeared as soon as medroxyprogesterone was neutralized (cf 1). There is no report of diabetes caused by the use of this drug among non-diabetic women.

The mechanism of increased blood glucose levels in relation to the use of medroxyprogesterone is not quite clear. A possible mechanism is the glucocorticoid action of progestogens: cortisol increases the blood glucose levels, increases insulin secretion, augments action of insulin response to glucose, and raises insulin resistance (cf 1).

There is no report of increased blood glucose levels in relation to medroxyprogesterone treatment in the files of the Swedish adverse effect registration. We recommend that this case should be reported to the Swedish Adverse Drug Reactions Advisory Committee if other reasons for increased blood glucose levels can be excluded.

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